MedicaidPrior AuthMedium impact
Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)
Humana·FL, KY, SC · Oncology, Hematology, Pharmacy·Medicaid
Effective date
Jan 1, 2019
We identified it
Jul 22, 2026
Summary
This is a recent revision (July 22, 2026) to Humana's Erwinase prior authorization policy for Medicaid members in Florida, Kentucky, and South Carolina. The policy establishes strict prior authorization requirements for Erwinase use in acute lymphoblastic leukemia (ALL) patients, requiring documented Grade 2-4 hypersensitivity to prior pegaspargase treatment and excluding patients with serious pancreatitis, thrombosis, hemorrhage, or disease progression history on asparaginase therapy.
Action Required
By July 22, 2026 (policy revision date): Billing team must implement prior authorization requirements for Erwinase (HCPCS code J9060) across Medicaid plans in Florida, Kentucky, and South Carolina. Update billing system to require prior auth submission with documentation of: (1) ALL diagnosis confirmation, (2) documented Grade 2-4 hypersensitivity to prior Oncaspar treatment based on CTCAE criteria, and (3) confirmation that Erwinase is used as part of multi-agent chemotherapy. Providers must screen for exclusion criteria (serious pancreatitis, thrombosis, hemorrhage, or disease progression history with asparaginase). Claims submitted without prior authorization or meeting exclusion criteria will be denied. Update encounter templates and claim submission workflows to capture required clinical documentation. Initial and renewal approvals valid for 6 months.